MEDICARE: COLORADO AND YALE DENTAL PARTNERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1922657436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO AND YALE DENTAL PARTNERS

Provider Business Mailing Address
First Line	:	2725 S COLORADO BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-6601
Country	:	US
Telephone Number	:	303-781-1810
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 S COLORADO BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-6601
Country	:	US
Telephone Number	:	303-781-1810
Fax Number	:

Authorized Official
Title or Position	:	OWNER, DENTIST
Name	:	DR. MATTHEW DAVID CARLSTON
Credential	:	DMD
Telephone Number	:	303-781-1810

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	09/06/2019

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